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Lookup NU author(s): Abdullah Malik, Dr Sam Tingle, Dr Ruth Owen, Dr Balaji Mahendran, Rodrigo Figueiredo, Dr Aimen Amer, Steven White, Professor Derek Manas, Professor Colin Wilson
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. BACKGROUND: The agonal phase can vary following treatment withdrawal in donor after circulatory death (DCD). There is little evidence to support when procurement teams should stand down in relation to donor time to death (TTD). We assessed what impact TTD had on outcomes following DCD liver transplantation. METHODS: Data were extracted from the UK Transplant Registry on DCD liver transplant recipients from 2006 to 2021. TTD was the time from withdrawal of life-sustaining treatment to asystole, and functional warm ischemia time was the time from donor systolic blood pressure and/or oxygen saturation falling below 50 mm Hg and 70%, respectively, to aortic perfusion. The primary endpoint was 1-y graft survival. Potential predictors were fitted into Cox proportional hazards models. Adjusted restricted cubic spline models were generated to further delineate the relationship between TTD and outcome. RESULTS: One thousand five hundred fifty-eight recipients of a DCD liver graft were included. Median TTD in the entire cohort was 13 min (interquartile range, 9-17 min). Restricted cubic splines revealed that the risk of graft loss was significantly greater when TTD ≤14 min. After 14 min, there was no impact on graft loss. Prolonged hepatectomy time was significantly associated with graft loss (hazard ratio, 1.87; 95% confidence interval, 1.23-2.83; P = 0.003); however, functional warm ischemia time had no impact (hazard ratio, 1.00; 95% confidence interval, 0.44-2.27; P > 0.9). CONCLUSIONS: A very short TTD was associated with increased risk of graft loss, possibly because of such donors being more unstable and/or experiencing brain stem death as well as circulatory death. Expanding the stand down times may increase the utilization of donor livers without significantly impairing graft outcome.
Author(s): Malik AK, Tingle SJ, Varghese C, Owen R, Mahendran B, Figueiredo R, Amer AO, Currie IS, White SA, Manas DM, Wilson CH
Publication type: Article
Publication status: Published
Journal: Transplantation
Year: 2024
Volume: 108
Issue: 11
Pages: 2238-2246
Print publication date: 01/11/2024
Acceptance date: 04/04/2024
Date deposited: 11/11/2024
ISSN (print): 0041-1337
ISSN (electronic): 1534-6080
Publisher: Lippincott Williams & Wilkins
URL: https://doi.org/10.1097/TP.0000000000005074
DOI: 10.1097/TP.0000000000005074
PubMed id: 38780399
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